Oncology Flashcards

1
Q

At what age do you expect to see childhood cancers peak. And what kind?

A

0-4yrs

Most to least:

  • Leukaemia
  • Brain tumours
  • Lymphoma
  • Other
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2
Q

What cancer is ass with the following syndromes?

  • Down’s
  • Fanconi
  • Neurofibromatosis
A

Downs = Leukaemia

Fanconi = Adult type cancers incl mouth, anal, vulval & leukaemia

Neurofibromatosis = Neurofibromas, sarcoma & leukaemia

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3
Q

How do we classify childhood cancers?

A

The International Classification of Childhood Cancers

It’s based on morphology unlike adult systems which use location

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4
Q

Childhood cancers can present with lot’s of non-specific symptoms e.g. weight loss, lumps, tiredness, seizures, headache, vomiting, fever etc.
When would you refer and how quickly?

A

Same Day:

  • Unexplained Petechiae
  • Hepatosplenomegaly

48hrs:

  • Repeat attenders with same problem but no diagnosis
  • New neuro symptoms
  • Abdo mass

2wks:

  • Rest pain, back pain or unexplained lump
  • Lymphadenopathy
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5
Q

In general what are the tests, staging methods and treatment for childhood cancers?

A

Imaging e.g. US, MRI, CT, X-ray
Tumour Markers
Biopsy
Staging with scans and bone marrow biopsy

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6
Q

Name 5 emergency presentations of a childhood cancer?

A

1) Sepsis or febrile neutropenia
2) Raised ICP
3) Spinal Cord Compression
4) Mediastinal syndromes
5) Tumour Lysis Syndrome

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7
Q

Known cancer patient comes in with:

  • Fever
  • Rigors
  • Drowsy
  • Tachycardia & Tachypnoea
  • Hypotensive
A

Sepsis

septic symptoms e.g. fever, rigors & drowsiness

+ shock symptoms e.g. tachy, hypotension, long cap refill, low UO & Metabolic acidosis

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8
Q

First off what are the risk factors for sepsis in a cancer kid?

A

Neutropenia
Mucosal inflammation
Catheter
Chemo

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9
Q

What organisms are likely to cause sepsis in a cancer kid?

A
Pseudomonas
E.coli
Pneumococcus
Enterococci
Staph
Fungi
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10
Q

How do you handle sepsis in these kids?

A

Inititate sepsis 6:

  • Fluids
  • Abx
  • O2
  • UO
  • Culture
  • Inotropes

Transfer to PICU

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11
Q

Kid with early morning headache & vomiting comes in, you notice a tense fontanelle and big head circumference?

A

Raised ICP (in this case from cancer)

Later they can get:

  • Constant headaches
  • Papillodema
  • Diplopia
  • Loss of upgaze
  • Neck stiffness
  • fits
  • Low GCS
  • Cushing’s Triad
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12
Q

If you see a kid with raised ICP how would you handle it?

A

Get an emergency CT (screen) & MRI (to confirm)

Give Dexamethasone (reduces cerebral oedema & raises CSF flow)

Neurosurgery e.g. Ventriculostomy or EVD

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13
Q

What tumours are likely to cause spinal cord compression in a kid and how would that present?

A

Ewing’s Sarcoma or MEdulloblastoma

Causes:
Weakness > Pain > Sensory impairment > sphincter disturbance

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14
Q

What do you do if you suspect spinal cord compression?

A

Urgent MRI

Followed by dexamethasone (then normal cancer treatment)

Outcome is related to degree of impairment rather than rapidity of treatment but still urgent!

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15
Q

What is SVS or SMS?

A

Superior Vena Cava/Mediastinal Syndrome

SVS is when a mediastinal mass (mostly lymphoma) compresses important structures:

  • Facial/neck/upper thoracic swelling
  • Cyanosis
  • Distended Veins
  • Generally unwell
  • Anxious
  • Low GCS

If it also affects the airways causing SOB, tachypnoea, cough, wheeze, stridor or orthopnoea it becomes SMS

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16
Q

How would you handle a kid presenting with SVS or SMS?

A

Do a CXR/CT if possible to confirm and an Echo

Keep them upright

Do urgent Biopsy, FBC, pleural aspirate & Germ cell tumour (GCT) markers

Get them on Steroids –> Chemo/RT
If thrombosis occurs use thrombolysis

17
Q

First off define Tumour Lysis Syndrome?

A

Rapid death of tumour cell (usually due to chemo) –> Release of intracellular contents e.g. K & PO4 –> Metabolic derangement & renal failure

18
Q

So how might Tumour Lysis Syndrome present?

A

Kid on chemo or other cancer therapy:

  • High K
  • high urate, urea & creatinine
  • High Phosphate
  • Hypocalcaemia
19
Q

How do you manage tumour lysis syndrome?

A

ECG monitoring (K) + electrolyte + UO

Hyperhydrate!

Rasburicase or Allopurinol for Uric acid

RRT e.g. Dialysis

No potassium & protect with Ca Gluconate,
Remove potassium with Ca Resonium, Salbutamol & insulin